Discussion on treatment methods of post-embolization recurrent intracranial aneurysms

Objective To investigate the efficacy of various treatment methods in patients with recurrent intracranial aneurysms post embolization. Methods From January 2015 to November 2017, 35 patients with recurrent intracranial aneurysms were admitted to Department of Neurosurgery, Zhongshan Hospital Affiliated to Xiamen University. Among them, 32 cases had anterior circulation aneurysms and 3 had posterior circulation aneurysms. There were 14 cases undergoing craniotomy (craniotomy group) and 21 cases undergoing interventional embolization (interventional embolization group). The surgical outcome was evaluated by modified Raymond-Roy grade (MRRC). Glasgow outcome scale(GOS) was used to evaluate the outcome of neurologic function. The treatment effect and outcome of neurologic function were compared between the 2 groups. Results In the interventional embolization group, MRRC grade Ⅰ was reported in 19 (90.5%) cases and grade Ⅱ in 2 (9.5%). In the craniotomy group, the proportion of patients with grade Ⅰ and grade Ⅱ was 13/14 and 1/14, respectively. There was no significant difference between the 2 groups (P>0.05). Hemiplegic paralysis occurred in one patient in craniotomy group. No postoperative complication was reported in interventional embolization group.The follow-up period was 6 to 24 months, with the median of 14 months. In terms of clinical outcome, the postoperative GOS grade in interventional embolization group was grade Ⅴ accounting for 100% (21/21). In the craniotomy group, the proportion of grade Ⅴ and grade Ⅳ were 13/14 and 1/14, respectively. There was no significant difference between the 2 groups (P>0.05). Conclusion For patients with recurrent aneurysms after embolization, both endovascular embolization and microcraniotomy ligation could achieve good outcome of neurologic function. Key words: Intracranial aneurysm; Recurrence; Treatment outcome; Craniotomy; Embolization, therapeutic